Vascular effects of the red blood cell storage lesion.
Vascular effects of the red blood cell storage lesion.
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DOI：
10.1182/asheducation-2011.1.475
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
Roback JD
中科院分区：
文献类型：
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作者：
Roback JD
对于贫血患者来说，输注红细胞(RBCs)通常是临床上必要的，也是挽救生命的。红细胞在捐献和输血之间可以保存长达42天。多年来，研究人员一直在研究输血前储存的红细胞(红细胞“储存损伤”)中发生的生化变化。最近，临床研究表明，长期储存(通常被描述为>；14-21天)的RBC单位可能会对接受者产生不良影响，导致发病率和死亡率。不幸的是，这些影响很难识别和研究，因为对于这些不良事件，没有达成一致的机制，也没有好的分析方法来研究个体输血接受者的影响。我们提出了无生物利用度不足的假说(INOBA)来解释与输注较老的红细胞单位相关的不良事件。INOBA假设，储存的红细胞产生的NO减少/清除的NO增加，再加上功能障碍的内皮细胞合成的NO减少，共同将血管床中的NO水平降低到临界阈值以下。在这种情况下，不适当的血管收缩会导致血流量减少，氧气供应不足。如果得到证实，INOBA假说可能导致改进血液储存和采集方法，以及为献血者和输血接受者提供新的筛查和配对工具。
Transfusion of red blood cells (RBCs) is often clinically necessary, and life-saving, for anemic patients. RBCs can be stored for up to 42 days between the time of donation and transfusion. For many years, investigators have studied the biochemical changes that occur in RBCs stored prior to transfusion (the RBC “storage lesion”). More recently, clinical studies have suggested that RBC units stored for long periods (often described as > 14–21 days) may mediate adverse effects in the recipient, leading to morbidity and mortality. Unfortunately, these effects are difficult to identify and study because there are no agreed upon mechanisms for these adverse events, and few good assays to study them in individual transfusion recipients. We have proposed the hypothesis of Insufficient NO Bio-Availability (INOBA) to explain the adverse events associated with transfusion of older RBC units. INOBA postulates that the combination of impaired NO production/increased NO scavenging by stored RBCs together with reduced NO synthesis by dysfunctional endothelial cells collectively reduce NO levels below a critical threshold in vascular beds. In this situation, inappropriate vasoconstriction occurs leading to reduced blood flow and insufficient O2 delivery to end organs. If confirmed, the INOBA hypothesis can lead to improved methods for blood storage and collection, as well as new screening and matching tools for blood donors and transfusion recipients.